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1 : RHEUMATOID ARTHRITIS Saurabh Garg
2 : Rheumatoid Arthritis Chronic multisystemic inflammatory disease of unknown etiology Affects the Synovial Membranes of multiple joints Female : Male ratio 3:1 Most frequent during 4th and 5th decade
3 : PATHOGENESIS
4 : Normal Synovial Joint Articular cartilage Synovium Membrane Lamellar bone Subchondral bone Type A cell: mphage like, protective role Type B cell: fibroblast like, produce matrix and synovial fluid Vessel Synovial Membrane: only 1-2 cells thick
5 : Thickened Synovium Lymphocytic Infiltrate Neovascularization EARLY CHANGES IN RA Major type of cells in synovium are T-cells and macrophages whereas in synovial fluid neutrophils are neutrophils
6 : Destruction of Joint Cartilage and Bone Proliferating synovial lining => Pannus Proliferating synovial lining comes in contact with the cartilage matrix and bone there is degradation of the cartilage and erosion of the bone surface (by matrix metalloproteinases and other proteases produced by synovial cells) Chondrocytes themselves IL-1 and TNF-alpha also stimulate production of metalloproteinase by Chondrocytes of the articular cartilage. In response to these cytokines, chondrocytes decrease type II collagen and proteoglycan synthesis and increase synthesis of metalloproteinases that contribute to the degradation of collagen and proteoglycans. Neutrophils in Synovial Fluid The main inflammatory cells of the synovial fluid are neutrophils. Cytokines such as transforming growth factor beta (TGF-beta) and interleukin 8 (IL-8) attract neutrophils. Neutrophils may undergo degranulation and cause some damage to surrounding tissues. Osteoclasts Osteoclasts may be activated by inflammatory mediators including IL-1, TNF and PGE2 bone cartilage
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8 : Rheumatoid Arthritis Clinical presentation usually presents insidiously; prodromal syndrome of malaise, weight loss and vague periarticular pain and stiffness may be seen less commonly, the onset is acute, triggered by a stressful situation such as infection, trauma, emotional strain or in the postpartum period. the joint involvement is characteristically symmetric with associated stiffness, warmth tenderness and pain
9 : Rheumatoid Arthritis Clinical Features the stiffness is characteristically worse in the morning and improves during the day; its duration is a useful indicator of the activity of the disease. the usual joints affected by rheumatoid arthritis are the metacarpophalangeal joints, the PIP joints, the wrists, knees, ankles and toes. Entrapment syndromes may occur especially carpal tunnel syndrome
10 : Rheumatoid Arthritis After months to years, deformities can occur; the most common are ulnar deviation of the fingers swan neck deformity, which is hyperextension of the distal interphalangeal joint and flexion of the proximal interphalangeal joint boutonniere deformity, which is flexion of the distal interphalangeal joint and extension of the proximal interphalangeal joint valgus deformity of the knee
11 : Extra-articular manifestations Rheumatoid nodules Vasculitis Ocular manifestations Keratoconjunctivitis sicca, episcleritis, scleritis, glaucoma Pulmonary manifestations Pleural involvement, Fibrosing alveolitis , Obliterative bronchiolitis Felty’s Syndrome - RA with Splenomegaly and neutropenia
12 : Extra-articular manifestations Cardiac involvement Constrictive pericarditis Renal involvement Secondary amyloidosis Neurologic manifestations Mononeuritis multiplex, entrapment neuropathies, peripheral neuropathies Hematological Anemia Thrombocytosis
13 : THANK YOU

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